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Abstract Details

Visual Disturbances Caused by Massive Musculoskeletal and Mediastinal Emphysema After Hip Arthroscopy
Neuro-ophthalmology/Neuro-otology
P2 - Poster Session 2 (11:45 AM-12:45 PM)
17-011
To describe massive gas entry into the body during hip arthroscopy as an uncommon occurrence that caused pneumomediastinum, gas tracking through the fascial planes and skull base, and infiltration of gas into the ciliary body, leading to transient visual disturbances.

A 19-year-old cross country runner underwent arthroscopy of the right hip for a labrum tear. After sitting up for a four-hour drive, the patient noted significant crepitations of her lower extremities associated with numbness and tingling over her hands and feet, along with visual disturbances.

An emergency department exam revealed crepitations of the lower extremities, abdomen, chest, and neck. The patient reported blurred vision and an inability to read. Uncorrected bilateral visual acuity was 20/20 for distance vision but 20/100 for near vision. Pupils were not reactive to light, did not accommodate to near target, and were mid-dilated at 5 mm.
NA

CT scan of the lower extremities and chest revealed massive subcutaneous emphysema involving the lower extremities, abdomen, chest, and neck, with pneumoperitoneum and pneumomediastinum.

The patient received four hyperbaric oxygen treatments (HBOT). By the third treatment, near visual acuity was 20/20. However, far visual acuity was now 20/50. This disappeared one week after discharge.
The patient’s presentation with lack of accommodation to near target and non-reactive dilated pupils was brought about by the penetration of gas around the eye. It is proposed that small bubbles either disrupted contractility of the ciliary muscles, causing an inability of the zonules to relax and thicken the crystalline lens, disrupting the near triad, or caused paresis of the iris sphincter muscle, resulting in partial mydriasis. Additionally, HBOT is known to cause “myopic shift” by causing changes in protein function of the crystalline lens and a transient increase in refractive index and temporary shift toward myopia.
Authors/Disclosures
Samuel J. Thomas
PRESENTER 		Mr. Thomas has nothing to disclose.
Adeela Alizai, MBBS (Indiana Eye institute) Dr. Alizai has nothing to disclose.
Mark Walsh IV, MD Dr. Walsh has nothing to disclose.
Marium Ansari Mrs. Ansari has nothing to disclose.
Duffy Monahan, Student Mr. Monahan has nothing to disclose.
Mubashir Raza, MBBS Dr. Raza has nothing to disclose.
Aida Ansari Ms. Ansari has nothing to disclose.
Yusuf Raza Mr. Raza has nothing to disclose.
Hala K. Ansari Miss Ansari has nothing to disclose.
Jeffery M. Bao Mr. Bao has nothing to disclose.
Syed Raza, MD Dr. Raza has nothing to disclose.